Fewer Children Were Up to Date on Routine Vaccinations in 2020 than in 2019

Before the COVID-19 pandemic, the US had a high rate of pediatric vaccination. The COVID-19 outbreak disrupted regularly scheduled healthcare visits, at which children would typically receive at specific intervals throughout infancy, childhood, and adolescence.

Early in the pandemic, the US Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics designated routine childhood vaccinations, especially for children younger than two, as a healthcare priority. However, there was still a reduction in ambulatory visits and vaccinations for all pediatric groups.

Stay-at-home orders and other COVID-19 management practices have since been relaxed, but pediatric well-child visits are still lagging. Acknowledging that communities of color were disproportionately affected by COVID-19, a study supported by the CDC evaluated trends in vaccination rates and the proportion of infants, children, and adolescents up to date (UTD) with vaccinations in 2020. The investigators explored variations in vaccination rates by age, race, and ethnicity using electronic health data from the Vaccine Safety Datalink (VSD).

Investigators conducted a surveillance study to analyze weekly routine childhood vaccination rates by age group over three periods in 2020 and the proportion of children UTD by age. The three periods were prepandemic (January

5, 2020-March 14, 2020), age-limited preventive care (March 15, 2020-May 16, 2020), and expanded primary care (May 17, 2020-October 3, 2020). These periods were chosen based upon date of the US emergency declaration, pandemic-associated healthcare changes with limited access to in-person ambulatory visits, and reopening of primary care facilities.

These results were then compared to the corresponding time periods in 2019 using a prepandemic and postpandemic control design. To be included in the week-specific analysis, children had to be enrolled during at least one day of that week. Included children were divided into the following age categories: younger than 24 months and 4-6, 11-13, and 16-18 years of age.

The investigators analyzed data from eight health systems in California, Oregon, Washington, Colorado, Minnesota, and Wisconsin via the Vaccine Safety Datalink. They used the US Advisory Committee on Immunization Practices recommendations to determine which vaccines should be included in the study and how to define UTD status.

Race and ethnicity were grouped by Hispanic or Latino, non-Hispanic Asian, non-Hispanic Black or African American, non-Hispanic white, and other, which included all individuals reporting multiple races and those with missing race and ethnicity data. Using this data, investigators compared age-specific vaccination rates during the specified periods in 2020 and 2019.

The evaluation of UTD status included 39113 children in 2020 and 40373 in 2019. The population was 49% female (n=1371718) and 51% male (n=1429979), 11.9% Asian(n=334216), 7.2% Black (n=201619), 32.1% Hispanic (n=900226), and 32.4% white (n=909189).

As with other studies, the investigators found a decline in vaccinations from the onset of the pandemic through May 2020. Lowered vaccination rates persisted in most age groups through September 2020, with only 74% of infants turning seven months UTD, compared to 81% in 2019.

Across most age groups and all time periods, Black children had the lowest UTD rate. This disparity existed before the pandemic, but after the outbreak of COVID-19, it became more pronounced for the 18-month-old group. Additionally, investigators found the most dramatic decreases in vaccination rates among those aged 4-6 years, 11-13 years, and 16-18 years during the period of age-limited preventive care (March 15, 2020-May 16, 2020). This is consistent with healthcare guidelines at the time, which prioritized vaccinations for children younger than 24 months.

A more extensive discussion of the results and limitations can be found in the study, published today in JAMA Pediatrics.

The investigators concluded that protection of the population from infectious disease depends on high vaccination rates. They recommended interventions to promote catch-up vaccination, especially in populations that had vaccine inequities prior to the COVID-19 pandemic.